LIVES; Friend Request

By DANIELA LAMAS

Published: March 14, 2010

Last winter, in the middle of my intern year, I became Facebook friends with a young man who was dying in the intensive-care unit. An investment banker in his mid-20s, he thought he was healthy until a fluttering in his chest and swollen ankles took him to a doctor. Now he was in the I.C.U. with a rare cardiac condition and the vague possibility of a transplant.

And his laptop. That's the first thing I noticed the morning a group of us stood outside his room on rounds. He was shocked by his internal defibrillator three times the night before -- died, that is, three times before being brought back with jolts of electricity. And this young man with a steroid-swollen face was surfing the Internet.

In medical school, when we cut open a cadaver and lifted the heart from its silent cage, it was beautiful and unreal. With this patient, it was clear to me that there would be no poetry. He was dying, and it would be ugly, and I knew I couldn't help him. He terrified me.

Eventually, I was sent in to pull a central line out of his neck. ''Hey,'' I said. I told him I was just going to cut out the stitches and then pull out the line -- basically a large IV for giving drugs -- from the vein deep inside. It would bleed, and I'd apply pressure for a while. When I pulled, I told him, I wanted him to hum.

''Hum?'' he said. He sounded like a regular guy, and I thought suddenly of fantasy football and beer.

''Uh . . . well, we don't want an air bubble,'' I said while I cut the sutures. ''Humming increases the pressure in your chest and keeps air from wanting to go in.''

I braced one hand against his shoulder and yanked the line out from his neck. ''Hmmmmmm. . . . '' His throat cracked, and I sensed he had a bad singing voice. I jammed the gauze down, but still blood dripped onto his gown, spreading into the fabric. I leaned my weight into his neck and felt him flinch. He turned his head toward the window, toward the snow.

''It's like Siberia out there,'' I said. It turned out he actually went there a few years before with friends. They took the Trans-Siberian Railway. ''That is so cool,'' I said.

''Are you on Facebook?'' he asked me. ''I'll friend you, and you can see the pictures.''

The last time a guy asked me that, I was in a crowded bar, giggling with the promise of meeting someone new. Now I was in the I.C.U. With every breath he took, I was scared the monitors would go off and he would die and I wouldn't know what to do.

That night, I went online and found the friend request. I clicked on his name. There he was, I thought, though not with swollen cheeks and belly, wasted arms and legs. This boy on Facebook was, well, hot. He was ''single,'' and he liked Radiohead and Tom Clancy. He'd been sending upbeat status updates from the I.C.U.; to read them, you'd never know he was so sick, but to me they were missives from a dying man.

My rotation in the I.C.U. ended soon after this, and I didn't see him. But when I couldn't sleep, sometimes I found myself opening his Facebook page, reading those status reports, glancing at his photos. Meanwhile, I learned that his kidneys were no longer working, that he kept spiking fevers, that he hadn't received a transplant.

And then a few weeks later, I received a message from him in my online in-box: ''Can I stop humming yet?''

I wish I could say that I responded, but instead I hesitated, and then signed off. I still don't know why. I didn't think there was an ethical principle about following a patient on Facebook, and I didn't worry that he'd see a picture of me in a bikini on my page. Maybe it was just that it had been weeks since that day I held pressure to his wound while he hummed, and I just couldn't believe he remembered.

After that, I wanted to go in and see how he was doing, but I didn't. I also stopped looking at his Facebook page, worried that he would somehow sense my online footprints. Months passed. One evening, I signed on to find his page filled with messages of condolence. They stretched for pages, and I read each one. Later, I signed on to our medical-records system and followed the notes that led -- inevitably now -- to his death. At the very end, I learned, his family said, enough.

Since then in my job, I've had to learn to look at death, in all its horrible manifestations, and not take pause. But I still find myself wishing for another chance to respond to that casual online message. To say: ''Hey, what's up? I'm sorry it took me so long to get back to you. You're O.K. to stop humming now.''

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